Lee Meng-Tse Gabriel, Lee Shih-Hao, Chang Shy-Shin, Chan Ya-Lan, Pang Laura, Hsu Sue-Ming, Lee Chien-Chang
From the Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan (M-TGL, S-HL, C-CL); Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (S-SC); Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan (S-SC); Department of International Business, Asia University, 500, Lioufeng Rd., Wufeng, Taichung City, Taiwan (Y-LC); Loyola University New Orleans College of Law 6363 St Charles Ave, New Orleans, LA (LP); Department of Business Administration, Tunghai University, Tunghai University, Taichung City, Taiwan (S-MH); and Department of Emergency Medicine and Department of General Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan (C-CL).
Medicine (Baltimore). 2015 Sep;94(39):e1662. doi: 10.1097/MD.0000000000001662.
No comparative effectiveness study has been conducted for the following 3 antibiotics: respiratory fluoroquinolones, β-lactam, and β-lactam + advanced macrolide. To gain insights into the real-world clinical effectiveness of these antibiotics for community-acquired pneumonia in adult outpatients, our study investigated the treatment failure rates in 2 million representative participants from the National Health Informatics Project (NHIP) of Taiwan. A new-user cohort design was used to follow NHIP participants from January 2000 until December 2009. Treatment failure was defined by either one of the following events: a second antibiotic prescription, hospitalization due to CAP, an emergency department visit with a diagnosis of CAP, or 30-day nonaccident-related mortality. From 2006 to 2009, we identified 9256 newly diagnosed CAP outpatients, 1602 of whom were prescribed levofloxacin, 2100 were prescribed moxifloxacin, 5049 were prescribed β-lactam alone, and 505 were prescribed advanced macrolide + β-lactam. Compared with the β-lactam-based regimen, the propensity score-matched odds ratio for composite treatment failure was 0.81 (95% CI, 0.67-0.97) for moxifloxacin, 1.10 (95% CI, 0.90-1.35) for levofloxacin, and 0.95 (95% CI, 0.67-1.35) for macrolide +β-lactam. Moxifloxacin was associated with lower treatment failure rates compared with β-lactam alone, or levofloxacin in Taiwanese CAP outpatients. However, due to inherent limitations in our claims database, more randomized controlled trials are required before coming to a conclusion on which antibiotic is more effective for Taiwanese CAP outpatients. More population-based comparative effectiveness studies are also encouraged and should be considered as an integral piece of evidence in local CAP treatment guidelines.
呼吸喹诺酮类、β-内酰胺类以及β-内酰胺类+高级大环内酯类。为深入了解这些抗生素对成年门诊患者社区获得性肺炎的实际临床疗效，我们的研究调查了台湾国家卫生信息项目（NHIP）中200万名具有代表性参与者的治疗失败率。采用新用户队列设计，对2000年1月至2009年12月期间的NHIP参与者进行随访。治疗失败定义为以下任一事件：第二次抗生素处方、因社区获得性肺炎住院、急诊科就诊且诊断为社区获得性肺炎或30天非事故相关死亡率。2006年至2009年，我们确定了9256例新诊断的社区获得性肺炎门诊患者，其中1602例患者使用左氧氟沙星治疗，2100例患者使用莫西沙星治疗，5049例患者单独使用β-内酰胺类治疗，505例患者使用高级大环内酯类+β-内酰胺类治疗。与基于β-内酰胺类的治疗方案相比，莫西沙星复合治疗失败的倾向评分匹配比值比为0.81（95%CI，0.67-0.97），左氧氟沙星为1.10（95%CI，0.90-1.35），大环内酯类+β-内酰胺类为0.95（95%CI，0.67-1.35）。在台湾社区获得性肺炎门诊患者中，与单独使用β-内酰胺类或左氧氟沙星相比，莫西沙星的治疗失败率较低。然而，由于我们的医保报销数据库存在固有局限性，在得出哪种抗生素对台湾社区获得性肺炎门诊患者更有效的结论之前，还需要更多的随机对照试验。还鼓励开展更多基于人群的比较疗效研究，并应将其视为当地社区获得性肺炎治疗指南中不可或缺的证据。
